Effect of different doses of dexmedetomidine on the coagulation function in elderly patients with tibiofibular fracture, and analysis of the influencing factors of postoperative recovery

ObjectiveTo explore the effects of different doses of dexmedetomidine on coagulation function in elderly patients with tibiofibular fractures, and analyze the influencing factors of postoperativem recovery.

MethodsOne hundred and seventy-one sacral fractures patients treated with open reduction internal fixation were randomly divided into the group A, group B and group C(57 cases in each group).The group A was treated with continuous epidural anesthesia, the group B was treated with continuous epidural anesthesia combined with 0.5 μg·kg·^-1·h^-1 dexmedetomidine intravenous infusion, and the group C was treated with continuous epidural anesthesia combined with 1.0 μg·kg·^-1·h^-1 dexmedetomidine intravenous infusion.The changes of coagulation function and stress response index among three groups were compared, and the influencing factors of postoperative recovery were analyzed.

ResultsAll patients were anesthetized successfully, and the operations were successfully completed.The differences of the analgesia time, anesthesia satisfaction, hemodynamic change and postoperative lower limb function recovery among three groups were not statistically significant(P>0.05).The differences of the ratios of healing, delayed healing and non-healing were statistically significant(P < 0.01).After 2 months of operation, the ankle function scores in group A, group B and group C showed the progressive phenomenon(P < 0.01).The differences of the APTT, PT, TT, Fib, SOD, MDA, NE and COR among three groups before operation were not statistically significant(P>0.05).After operation, the levels of APTT, PT, TT, MDA, NE and COR in group A and group B increased(P < 0.05), the levels of Fib and SOD in A and B groups decreased, and there was no change in group C(P>0.05).The level of SOD was positively correlated with the levels of APTT, PT and TT(P < 0.05 to P < 0.01), and negatively correlated with Fib(P < 0.01).The levels of MDA, NE and COR were negatively correlated with the levels of APTT, PT, TT(P < 0.05 to P < 0.01), and positively correlated with Fib(P < 0.05 to P < 0.01).The results of univariate and logistic regression analysis showed that fracture type, difference of coagulation index(APTT, PT, TT and Fib) between before and after operation, and difference of stress response index(SOD, MDA, NE, COR) between before and after operation were the risk factors affecting postoperative recovery(P < 0.05 to P < 0.01).

ConclusionsThe post-anesthesia stress response affects the coagulation function in elderly patients with tibiofibular fractures, which together affect fracture healing.The inhibitory effects of dexmedetomidine on stress response and postoperative coagulation function are correlated with dose.Compared with low dose of 0.5 μg·kg·^-1·h^-1, the effects of high dose of 1.0 μg·kg·^-1·h^-1 is better.